Carbapenem associated seizure in a severe melioidosis patient: A case report

Abstract

Abstract. The use of carbapenems has beenassociated with increased risk of seizure with imipenem having a higherpropensity to induce seizure as compared to meropenem. As there is limited report onthe cross-reactivity between these two agents, clinicians may choose to switchthe antibiotic regimen to meropenem whenever an imipenem associated seizure issuspected. We described a 67-year-old woman who was admittedto the intensive care unit due to severe melioidosis. She experienced anepisode of myoclonus jerks following two doses of imipenem 500 mg givenintravenously at 12 hour interval. Two hours after her first seizure, thepatient experienced two more myoclonus jerks which were two hours apart of eachother. Imipenemwas then discontinued and meropenem 1 g stat and followed by 500 mg every 12 hourly was givenintravenously. However, patient continued to experience myoclonus jerks withthe first episode occurring four hours after the initiation of meropenem.Phenytoin 100 mg every 8 hourly was given intravenously for the management ofseizure. However, the frequency of myoclonus jerks increased to a total of 14episodes on the next day.  The phenytointherapy was subsequently substituted with intravenous sodium valproate 750 mgstat followed by 400 mg every 12 hourly. With this change in treatment,patient’s seizure was resolved. The present case showed thepossibility of cross-reactivity in neurotoxicity which occurred across the useof imipenem and meropenem. Key words: Carbapenem, imipenem,meropenem, seizure, melioidosis

Keywords

• Carbapenem, imipenem, meropenem, seizure, melioidosis

Kaynakça

1. Suputtamongkol Y, Hall AJ, Dance DAB, et al. The epidemiology of melioidosis in Ubon Ratchathani, Northeast Thailand. Int J Epidemiol 1994; 23: 1082-1090.
2. Cheng AC, Currie BJ. Melioidosis: Epidemiology, pathophysiology, and management. Clin Microbiol Rev 2005; 18: 383-416.
3. Puthucheary SD. Melioidosis in Malaysia. Med J Malaysia 2009; 64: 266-274.
4. Inglis TJJ. The treatment of Melioidosis. Pharmaceuticals 2010; 3: 1296-1303.
5. Ministry of Health Malaysia. National Antibiotic Guideline 2008. Putrajaya: Ministry of Health Malaysia, 2008.
6. Chaowagul W. Recent advances in the treatment of severe melioidosis. Acta Trop 2000; 74: 133-137.
7. Zhanel GG, Simor AE, Vercaigne L, et al. Imipenem and meropenem: Comparison of in vitro activity, pharmacokinetics, clinical trials and adverse effects. Can J Infect Dis 1998; 9: 215-228.
8. Koppel BS, Hauser WA, Politis C, et al. Seizures in the critically ill: the role of imipenem. Epilepsia 2001; 42: 1590-1593.

9. Calandra G, Lydick E, Carrigan J, et al. Factors predisposing to seizures in seriously ill infected patients receiving antibiotics: Experience with Imipenem/Cilastatin. Am J Med 1988; 84: 9119
10. Pestotnik SL, Classen DC, Evans RS, et al. Prospective surveillance of imipenem/cilastatin use and associated seizures using a hospital information system. Ann Pharmacother 1993; 27: 497-50
11. Norrby SR, Newell PA, Faulkner KL, et al. Safety profile of meropenem: international clinical experience based on the first 3125 patients treated with meropenem. J Antimicrob Chemother 1995; 36: 207-223.
12. Cunha B. Meropenem in elderly and renally impaired patients. Int J Antimicrob Agents 1998; 10: 107-117.
13. Puthucheary SD, Parasakthi N, Lee MK. Septicaemic melioidosis-a review of 50 cases from Malaysia. Trans R Soc Trop Med Hyg 1992; 86: 683-6
14. Pryka RD, Haig GM. Meropenem: a new carbapenem antimicrobial. Ann Pharmacother 1994; 28: 1045-1054.
15. Chow K, Hui A, Szeto C. Neurotoxicity induced by beta-lactam antibiotics: from bench to bedside. Eur J Clin Microbiol Infect Dis 2005; 24: 649-653.
16. De Sarro A, De Sarro GB, Ascioti C, et al. Epileptogenic activity of some beta-lactam derivatices: structure-activity relationship. Neuropharmacology 1989; 28: 359-365.
17. Williams PD, Bennett DB, Comereski CR. Animal model for evaluating the convulsive liability of beta-lactam antibiotics. Antimicrob Agents Chemother 1988; 32: 758-760.
18. Seto AH, Song JC, Guest SS. Ertapenemassociated seizures in a peritoneal dialysis patient. Ann Pharmacother 2005; 39: 352-356.
19. Ortiz-Ruiz G, Caballero-Lopez J, Friedland IR, et al. A study evaluating the efficacy, safety, and tolerability of ertapenem versus ceftriaxone for the treatment of community-acquired pneumonia in adults. Clin Infect Dis 2002; 34: 1076-1083.
20. Miller AD, Ball AM, Bookstaver PB, et al. Epileptogenic potential of carbapenem agents: Mechanism of action, seizure rates, and clinical considerations. Pharmacotherapy 2011; 31: 4084
21. Product Information. Primaxin ® (imipenem/cilastatin) IV. West Point, PA: Merck & Co, Inc., 1999.
22. Product Information: Merrem ® (meropenem) IV. Wilmington, DE: AstraZeneca Pharmaceuticals LP, 2010.
23. Naranjo CA, Busto U, Sellers EM, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther 1981; 30: 239-245.
24. Wong K, Chan WK, Chan Y, et al. Cefepimerelated neurotoxicity in a hemodialysis patient. Nephrol Dial Transplant 1999; 14: 2265-2266.
25. Product Information: Zithromax ® (azithromycin) IV infusion. New York, NY: Pfizer, Inc., 2011.
26. Odeh M, Lavy A, Stermer E. Hydrocortisoneinduced convulsions. J Toxicol Clin Toxicol 2003; 41: 995-997.
27. Product Information: Tamiflu ® (oseltamivir) oral capsules, suspension. Foster City, CA: Roche, 200 Antoniadis A, Müller WE, Wollert U. Inhibition of GABA and benzodiazepine receptor binding by penicillins. Neurosci Lett 1980; 18: 309-312.
28. Berkovic SF. Aggravation of generalized epilepsies. Epilepsia 1998; 39: 11-14.
29. Scottish Intercollegiate Guidelines Network. Diagnosis and management of epilepsy in adult: A national clinical guideline. Edinburgh: Scottish Intercollegiate Guidelines Network, 2003.
30. National Institute for Clinical Excellence. The epilepsies: The diagnosis and management of the epilepsies in adults and children in primary and secondary care. London: National Institute for Clinical Excellence, 2004.
31. Clause D, Decleire PY, Vanbinst R, et al. Pharmacokinetic interaction between valproic acid and meropenem. Intensive Care Med 2005; 31: 1293-1294.
32. Tobin JK, Golightly LK, Kick SD, et al. Valproic acid-carbapenem interaction: report of six cases and a review of the literature. Drug Metabol Drug Interact 2009; 24: 153-182.
33. Simpson AJH, Suputtamongkol Y, Smith MD, et al. Comparison of imipenem and ceftazidime as therapy for severe melioidosis. Clin Infect Dis 1999; 29: 381-387.
34. Cheng AC, Fisher DA, Anstey NM, et al. Outcomes of patients with melioidosis treated with meropenem. Antimicrob Agents Chemother 2004; 48: 1763-1765.